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Legs in the water for aquatic exercise

Pool Therapy: The Best Aquatic Exercises for Knee Pain

Pool Exercises for Knee Pain

The Best Aquatic Exercise for Knee PainKnee pain can take a huge toll on your day-to-day life. We use our knees with nearly every movement we make. Having pain in your knee can impact you when walking, taking stairs, and even just standing. There are many inner workings in our knee joint, which means there are a lot of things that can get injured or inflamed, causing discomfort. In the current research, the best way to help manage and prevent knee pain is through strengthening and exercise. How do you exercise if your knees hurt? One of the best ways to start exercising is using the benefits of the pool to provide a less painful way to get started.

Common Causes of Knee Pain

Knee pain is very common, especially among athletes and adults. We use our knees daily, and even normal activities can begin to cause wear and tear on the joint. Some common knee issues are:

person grabbing knee because of knee pain in sittingArthritis: This is a degenerative process where the cartilage gradually wears away over time. This usually affects people who are overweight, have had a previous series knee injury, or who have been sedentary in their activity. Pool exercises are a great option for osteoarthritis.

Tendonitis: Overuse and activities like running, jumping, bending, and cycling can cause inflammation of the tendons in the knee.

Sprained/Strained Ligaments or Muscles: Any sudden twists can cause your ligaments or muscles to get pulled too far, too quickly. A hit to the knee can cause this as well. This can result in a strain or sprain or what is also small tears in the soft tissue.

Torn Cartilage: There are pads of tissue inside of your knee call the Meniscus, and with any kind of trauma or injury they can tear. Sometimes sprains also result in torn cartilage, depending on the severity of the injury.

Bursitis: There are small sacs of fluid that help cushion the outside of your knee and the tendons from having too much friction. Injury can cause swelling, and inflammation of these bursae results in pain. These injuries can make it hard to tighten your muscles without discomfort.

Why Aquatic Exercises Help with Knee Pain

Water exercise is a great way to work out your knee safely. The added buoyancy allows you to keep weight off of the joint but still allows you to have resistance to build up the muscles and tendons. This reduces the weight in your joints for movements such as squats, lunges, and even jumping.

aquatic exercise for knee painGetting your knee moving will allow better blood flow to the area, which will aid in the healing process. Over time this will reduce swelling and edema while increasing flexibility. Even those with very limited mobility who find movement painful can utilize water to aid with exercise. It adds stability and decreases discomfort. It’s a great method to help with arthritis pain because it eliminates a lot of strain on the joints, allowing you better mobility to get your knee moving.

Plus the warmth of the water adds a therapeutic effect. The warm causes muscles to relax and become more flexible. The pain receptors in the joint aren’t as active when under heat, so the pain isn’t as severe.

Who Might Benefit from Aquatic Exercises

Aquatic exercise is a great solution for those who have:

  • Anyone that had surgery but isn’t allowed to put full weight into the knee
  • Anyone with a history of a severe injury to the knee
  • Arthritis 
  • Those who have very limited mobility
  • Anyone that is obese and can’t seem to begin exercise

Allowing yourself to use the resistance of the water without forcing your knee to support all of your weight can help you have more freedom in your movements. Feeling less pain while you are building up strength will allow you to push yourself while not putting excessive strain on the knee joint. Additionally, these exercises in the water will engage all of your muscles and ligaments, allowing you to strengthen the entire joint quicker.

Tips to For Aquatic Exercise

The Deeper the Water, the Easier the Exercise

The deeper you go into the water the less weight in the joints and the more buoyancy the pool will provide. This means to get more resistance you need to move to the shallow section of the pool. To get less resistance then move to the deeper into the pool to take the weight off the joints. If you try a squat in the shallow end and you have knee pain, then move to a little deeper part of the pool and try again.

Wear Water Shoes

Barerun water shoes for aquatic exerciseIt’s important to wear water shoes if you going to any public pool or recreation center for a variety of reasons. Water shoes help with sanitation and germs in the locker rooms, provides move cushion when walking around the deck, and finally the shoes provide much needed traction when performing some of the exercises. We recommend the Barerun Water shoes because they are so darn cheap and comfy.

Use Weights to Make it Harder

hand held water weights for exerciseIf you are doing aquatic exercise after surgery or as an athlete then you will likely need more resistance. You can use ankle weights to make the leg exercsies, walking, and even running in the pool harder. If you use the dumbbell weights, these are perfect for core exercises, running, and any upper extremity exercises. Most large pools will have the water weights already on site but you can always buy your own, especially if you have your own pool.

The Best Water Exercises for Knee Pain

Warm Up with an Underwater Bike

Warming up and prolonged exercise are two of the most important aspects to manage knee pain. This can be hard to do in the pool. One of the best ways is to use an underwater bike. Most large recreation or YMCAs should have them. Underwater Bike for Knee pain If you have your own pool then you can order one on Amazon and leave it in the pool. Beyond using it for warming up you can also use to increse endurance, increase strength, and improve cardiovascular fitness. If you don’t have access to an underwater bike then you can warm up but walking in the shallow part of the pool, against the lazy river, or start with mini squats. If you haven’t seen an underwater bike be sure to click on the link to chect it out.

Standing Hip Abduction with or without a Band

It’s important to build and strengthen other muscles you use in everyday activities. This is a low-level exercise that will help you strengthen your Gluteus Medius which is extremely important in controlling the rotation the knee joint.resistance bands for the pool It’s important to keep your hips flat and level during this exercise. Use a chair or wall to maintain balance, and while standing bring your leg out to the side, going slightly backward. Repeat this motion 10-20 times for atleast 3-4 sets. You’ll feel this exercise in the side of the hips. To make this harder for anyone that feels like that can, we recommend using a resistance loop band (yes this can go in the pool if clean) and wrap it around the ankles. Our favorite resistance bands are the Perform Better Bands as they come in a variety of difficulties and last the longest.

*** To see how to perform this exercise with a resistance band click here: Hip Abduction with Band

Foot on the Step Hamstring Stretch

This stretch is meant to loosen your hamstring muscles. Place one foot forward, slightly bending the other knee. Push your bottom out while leaning forward until you feel a stretch on the back of your leg in the hamstring muscle. You want to hold this for at least 30 seconds and do it more than 3 times. Don’t forget to swith legs. The most important part of this stretch is to try and get the knee all the way straight. The more knee extension that you can get, the more success of reducing knee pain you’ll have.

Stair Step-Ups in the Pool

Starting in the pool by the steps, you will step forward and up, raising yourself out of the pool. You can hold on to the railing for extra support if needed. The water will add resistance as you step up. Be sure to keep your back straight and you should feel your weight on the back of your heel, and you step forward. This is a great exercise not only for your knee, but also for your quadriceps which provide 60% of the function of the knee. This exercise will also target hip and calf muscles with is perfect for progressing to pain free walking.

Calf Raises in the Pool

This is a classic exercise that targets the calf muscles. Many people don’t realize it but the calf muscle tendons actually go as high as crossing above the knee. Start by standing in the water with your feet planted on the bottom of the pool. Using your calf muscles, lift your heels and end your motion at the balls of your feet. Slowly lower your body back down until your feet are planted again. You can use the edge of the pool for extra balance if needed. This exercise is also great to improve balance, help with normalizing gait, and improve blood flow back to the heart. You can guarantee this exercise is on almost all aquatic exercise recommendations.

Aquatic Reverse Lunge

Start in a standing position with your feet together. While in the water, keep one leg planted directly under you. Bend that knee while moving the other leg back behind you. For balance as you are lunging backward, raise your arms out in front of your body. aquatic ankle weightsNow stand up and bring your leg forward. Be sure to keep your chest up the whole time. Try and maintain as much weight in the stance leg as possible and you may be able to do it without touching the moving leg at all. This exercise is great because it works on strength, balance, and multiple muscles as once. If this is too easy you may try using an aquatic adjustable ankle weight  to provide more resistance.

Mini Squats in the Pool

For this exercise, you want to stand with your feet about shoulder-width apart. You will then bend down into a squat position, making sure your knees stay behind your feet. There are varying difficulties you can do with this exercise. For the easiest method, stand with your back against the wall as you squat. The more your body is out of the water, the harder this activity is. For an advanced version, start on a stair with your upper body out of the water as you squat. This movement is one of the best ways to strength the muscles around the knee and perfect for anyone recovering from surgery.

Water Walking

While in the water, keep your body upright. As you walk forward be sure to walk heel-first and roll your weight to the front of your foot. You can also walk backwards, but in that direction, you want your weight to hit the front of your foot first. Side stepping will help build those outer leg muscles. Be sure to keep your feet pointing forward the whole time, and not to point your foot outward. For an advanced technique, you can “march” in the water. You will do this the same way as walking forward, but with each step you will pull your knee up as far as you can. One of the favorite ways to exercise is to walk Against the current in a lazy river of against resistance jets.


Knee pain can impact your daily life and make everyday activities difficult and painful. Regardless of your age or physical ability, you can utilize exercise to help strengthen your knee. Keeping your knee moving will increase blood flow and aid with healing.

Utilizing water to exercise your knee is a safe and effective method. There are plenty of activities you can do to not only strengthen your knee joint, but also the muscles and ligaments that support your knee. Start small and build up your level of difficulty as your strength and flexibility increase. Don’t neglect other muscle groups, and always stretch before and after exercising.


Works Cited:

Disclaimer: The information provided in this post is for educational purposes only. This is not a substitute for a medical appointment. Please refer to your physician before starting any exercise program.